Iron Deficiency in Pregnancy

Symptoms, Testing, Treatment and Why Current Screening Is Not Enough

Iron deficiency is the most common nutritional issue in pregnancy. In Australia, up to 60–70 percent of women are identified with low iron during routine screening. Because your body needs almost double the iron to grow a healthy baby, iron deficiency can affect your energy, your birth experience, your mental health, and your baby’s development. It is also linked with an increased risk of postpartum depression and a higher risk of postpartum bleeding.

Recently, I attended a postpartum conference where the topic of iron testing and management was raised. I shared my frustration that iron is tested too infrequently, often too late in pregnancy, and not monitored closely enough throughout gestation. The response was sobering: funding does not currently prioritise routine, frequent iron testing in pregnancy.

But when we know that low iron significantly increases the risk of postpartum depression, and that postpartum women are already slipping through the cracks, we cannot accept this as good enough. Mothers deserve better. Earlier and more frequent testing must become standard care.

This article outlines the key symptoms, testing recommendations, treatment options, and how to support optimal iron levels through food, supplements, and proactive care.

Why Iron Matters in Pregnancy

Iron plays several essential roles:

Supports your blood supply

Pregnancy increases blood volume and requires more haemoglobin to carry oxygen.

Builds your baby’s brain and body

Iron is crucial for fetal growth and neurological development.

Protects you during birth

Low iron increases the risk of postpartum haemorrhage, infection, and the need for blood transfusion.

Reduces long-term risks for your baby

Severe deficiency is linked with preterm birth, low birthweight and poor feeding.

Symptoms of Low Iron in Pregnancy

These can overlap with normal pregnancy changes, but persistent or worsening symptoms should not be ignored.

Common symptoms include:

• Constant fatigue or weakness

• Shortness of breath or palpitations

• Headaches or dizziness

• Restless legs

• Pale skin, brittle nails, or hair shedding

• Mood changes, anxiety, depression

If you notice any of these, ask your GP, midwife or naturopath for iron testing.

How Iron Deficiency Is Diagnosed

In Australia, typical antenatal screening includes:

Early pregnancy: Full blood count and ferritin

Mid pregnancy: Often not repeated until 28–36 weeks under standard care

Symptom-based testing: Should occur any time there are symptoms

Optimal testing, however, should be every 4–6 weeks, not just once early and once late.

Diagnostic thresholds:

• Ferritin less than 30 µg/L indicates deficiency

• Haemoglobin less than 11 g/dL indicates anaemia

• Transferrin saturation and reticulocyte haemoglobin can diagnose functional iron deficiency

Why Prevention Matters

Waiting until iron drops too low usually means late pregnancy stress, higher dose supplements, and more side effects.

Better care includes:

Preconception testing: Getting ferritin and haemoglobin checked before conceiving.

Early pregnancy screening: Requesting a full iron study at your first antenatal visit.

Ongoing monitoring every 4–6 weeks: Current standard care often skips months of potential decline.

How to Increase Iron in Pregnancy

Food First Approach

Heme iron sources: beef, lamb, chicken, fish, eggs

Non-heme sources: lentils, beans, tofu, pumpkin seeds, leafy greens

Boost absorption

• Add Vitamin C with meals

• Cook in cast iron

• Avoid tea, coffee, and dairy around iron-rich meals

Supplements

Because demand is so high, many women require supplementation.

Prevention: Prenatals offer small amountsTreatment: Tailored iron dosing based on levels and symptoms

Alternate day dosing improves absorption and reduces constipation, nausea, and digestive upset.

When IV Iron Is Needed

• Severe anaemia

• Poor tolerance to oral iron

• Late pregnancy needing rapid correction

Frequently Asked Questions

What causes iron deficiency in pregnancy?

Higher demand, nausea, dietary gaps, short spacing between pregnancies, or heavy menstrual loss.

Can low iron affect mental health?

Yes. Iron deficiency is strongly linked with higher rates of depression during pregnancy and postpartum.

How often should I get tested?

Ideally: before conception, then every 4–6 weeks throughout pregnancy, with ferritin, haemoglobin, and ideally full iron studies.

Do I need iron after birth?

Often yes, especially if you had blood loss or low levels during pregnancy.

Key Takeaways

• Iron deficiency is extremely common and often missed until late pregnancy.

• It increases the risk of postpartum depression, fatigue, birth complications, and slower maternal recovery.

• Testing should occur far more frequently than is currently funded.

• Early detection and treatment support better maternal well-being and healthier outcomes for babies.

If you are feeling tired, flat, or not quite yourself, it’s worth checking your iron.

Book in with one of our practitioners for personalised support and a thorough iron review.We ensure you receive evidence-based, compassionate, and timely care so you don’t fall through the gaps.

References

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